The role of acute and chronic respiratory colonization and infections in the pathogenesis of COPD

被引:184
作者
Leung, Janice M. [1 ,2 ]
Tiew, Pei Yee [3 ]
Mac Aogain, Micheal [4 ]
Budden, Kurtis F. [5 ,6 ]
Yong, Valerie Fei Lee [4 ]
Thomas, Sangeeta S. [4 ]
Pethe, Kevin [4 ]
Hansbro, Philip M. [5 ,6 ]
Chotirmall, Sanjay H. [4 ]
机构
[1] Univ British Columbia, Ctr Heart Lung Innovat, St Pauls Hosp, Vancouver, BC, Canada
[2] Univ British Columbia, St Pauls Hosp, Div Resp Med, Vancouver, BC, Canada
[3] Nanyang Technol Univ, Singapore Gen Hosp, Dept Resp & Crit Care Med, Singapore, Singapore
[4] Nanyang Technol Univ, Lee Kong Chian Sch Med, Clin Sci Bldg,Novena Campus, Singapore 308232, Singapore
[5] Univ Newcastle, Prior Res Ctr Hlth Lungs, Newcastle, NSW, Australia
[6] Hunter Med Res Inst, Newcastle, NSW, Australia
基金
英国医学研究理事会;
关键词
acute exacerbations of chronic obstructive pulmonary disease; chronic obstructive pulmonary disease; colonization; infection; microbiome; OBSTRUCTIVE PULMONARY-DISEASE; AIR-FLOW OBSTRUCTION; NONTYPABLE HAEMOPHILUS-INFLUENZAE; ALVEOLAR MACROPHAGE RESPONSE; LATENT ADENOVIRAL INFECTION; CIGARETTE-SMOKE EXPOSURE; ACUTE EXACERBATIONS; RISK-FACTORS; PSEUDOMONAS-AERUGINOSA; SYSTEMIC INFLAMMATION;
D O I
10.1111/resp.13032
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
COPD is a major global concern, increasingly so in the context of ageing populations. The role of infections in disease pathogenesis and progression is known to be important, yet the mechanisms involved remain to be fully elucidated. While COPD pathogens such as Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae are strongly associated with acute exacerbations of COPD (AECOPD), the clinical relevance of these pathogens in stable COPD patients remains unclear. Immune responses in stable and colonized COPD patients are comparable to those detected in AECOPD, supporting a role for chronic colonization in COPD pathogenesis through perpetuation of deleterious immune responses. Advances in molecular diagnostics and metagenomics now allow the assessment of microbe-COPD interactions with unprecedented personalization and precision, revealing changes in microbiota associated with the COPD disease state. As microbial changes associated with AECOPD, disease severity and therapeutic intervention become apparent, a renewed focus has been placed on the microbiology of COPD and the characterization of the lung microbiome in both its acute and chronic states. Characterization of bacterial, viral and fungal microbiota as part of the lung microbiome has the potential to reveal previously unrecognized prognostic markers of COPD that predict disease outcome or infection susceptibility. Addressing such knowledge gaps will ultimately lead to a more complete understanding of the microbe-host interplay in COPD. This will permit clearer distinctions between acute and chronic infections and more granular patient stratification that will enable better management of these features and of COPD.
引用
收藏
页码:634 / 650
页数:17
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